THE STATE OF NEW HAMPSHIRE JUDICIAL BRANCH http://www.courts.state.nh.us Court Name: Case Name: Case Number: (if known) Estate of PETITION FOR SMALL ESTATE ADMINISTRATION Original 1. Petitioner Name Mailing Address 2. Petitioner Name Mailing Address 3. Attorney Name Firm name Mailing Address 4. Deceased Name Date of Death Amended Telephone Telephone Telephone Bar ID# Residence (city or town) 5. 6. 7. Deceased died: Petitioner was: with will named without will not named in will of the deceased. Petitioner's relationship to deceased: Instructions for completing this section of the form. List only personal property such as cash, bank accounts, stocks, bonds, vehicles; no real estate is allowed on a small estate administration (aka voluntary administration). In the description of assets section, include specific identifying information such as: model, vehicle identification number, serial numbers, name of bank and account numbers, certificate of deposit numbers, etc. If this is an amended petition, list the new assets followed by the total value of the estate reported on the original petition. ASSETS DESCRIPTION OF ASSETS $ $ $ $ $ $ $ VALUE Total value of personal estate reported on original petition (if this is amended petition) Descriptions listed on previous petition(s). $ $ American LegalNet, Inc. www.FormsWorkFlow.com TOTAL PERSONAL ESTATE ­ NOT TO EXCEED $10,000 NHJB-2141-P (03/25/2013) Page 1 of 2 Case Name: Estate of Case Number: PETITION FOR SMALL ESTATE ADMINISTRATION Petitioner asks to serve as voluntary administrator of such estate and will administer the same according to law. I certify that on this date I provided this document(s) to the parties who have filed an appearance for this case or who are otherwise interested parties by: Hand-delivery OR US Mail OR Email (E-mail only by prior agreement of the parties based on Circuit Court Administrative Order). Date Petitioner Signature (must be signed in presence of notarial officer) Date Petitioner Signature (must be signed in presence of notarial officer) State of This instrument was acknowledged before me on , County of by Date Petitioners My Commission Expires Affix Seal, if any Signature of Notarial Officer / Title ORDER The voluntary administrator's authority to administer is expressly limited only to asset(s) listed on this form. Out of the assets collected, the voluntary administrator shall pay debts and expenses of the estate in accordance with RSA 167:13, 554:19 or 557:34 as applicable, and shall take no fees for his/her services. A statement of administration must be filed no earlier than 60 days, nor later than 90 days, from the administrator's appointment. If an amended petition is filed, the original due dates are applicable. No distribution of the final balance shall be made until the statement is approved by the court. Any distribution should be according to the will of the deceased, if any, or if no will, in accordance with RSA 561. If letters testamentary or of administration are later granted, the voluntary administrator's power shall cease, and he/she shall deliver to the rightful executor or administrator all assets and funds of the estate in his/her possession, and file a statement of administration with the court. Petition for Small Estate Administration is granted. Petition for Small Estate Administration is denied. Date Judge American LegalNet, Inc. www.FormsWorkFlow.com NHJB-2141-P (03/25/2013) Page 2 of 2